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Villanueva-Blasco VJ, Eslava D, Olave L, Torrens M. Electronic interventions in primary care to address substance use: A systematic review. Addict Behav 2024; 156:108073. [PMID: 38821009 DOI: 10.1016/j.addbeh.2024.108073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/16/2024] [Accepted: 05/20/2024] [Indexed: 06/02/2024]
Abstract
The present systematic review aims to identify electronic interventions for addressing substance use and understand their effectiveness in primary care settings. A systematic search was carried out in the Web of Science, PubMed/MEDLINE, Scopus, and Cochrane Library. The search included the keywords "electronic intervention", "substance use", "primary care" and synonyms. To determine the quality and recommendation of the analyzed interventions, the efficacy results reported by the studies were considered, as well as the Mixed Methods Appraisal Tool (MMAT) assessment and the GRADE Evidence Assessment. Twenty-one electronic interventions in Primary Care were identified: internet, mobile or tablet applications, text messages, emails, automated telephone calls, or electronic self-reports. These interventions had diverse components, incorporating theories that have proven effective in face-to-face interventions as their theoretical frameworks. Some of them were complementary to in-person treatment, while others replaced it. Six interventions (28.5 %) displayed high quality: HealthCall, AB-CASI, Quit Genius, eCHECKUP-TOGO, CBI, and TES. Another nine interventions (42.8 %) were found to have moderate-high quality: Alcohol y Salud, IVR-BI, Program of Wallace et al., Let's Talk About Smoking, SMSalud, ESCAPE, AAC-ASPIRE, iQuit, and Programa VIH. One intervention (4.7 %) had moderate-low quality: Vive sin tabaco ¡Decídete! The remaining five interventions (23.8 %) were found to have very low quality: Connection to health, cSBI, Teen Well Check, the program of Helzer et al. (2008), and Down your drink. The programs with the highest recommendation for addressing alcohol-related issues are HealthCall and AB-CASI; for tobacco use, it is Quit Genius; for cannabis use, it is eCHECKUP-TOGO; for addressing both legal and illegal substances, it is CBI and TES. Finally, for specific illicit drug use, the only recommended program is CBI. This last intervention, CBI, is of the highest quality and, therefore, can be considered a model intervention for dissemination in the primary care setting.
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Affiliation(s)
- Víctor J Villanueva-Blasco
- Faculty of Health Sciences, Valencian International University, C/ Pintor Sorolla, 21, 46002, Spain; Research Group on Health and Psycho-Social Adjustment (GI-SAPS), Valencian International University, Spain; Research Network in Primary Addiction Care (RIAPAd), Spain.
| | - Dalila Eslava
- Research Network in Primary Addiction Care (RIAPAd), Spain; Faculty of Human Sciences and Education, University of Zaragoza, Spain.
| | - Leticia Olave
- Faculty of Health Sciences, Valencian International University, C/ Pintor Sorolla, 21, 46002, Spain; Research Group on Health and Psycho-Social Adjustment (GI-SAPS), Valencian International University, Spain.
| | - Marta Torrens
- Research Network in Primary Addiction Care (RIAPAd), Spain; Addiction Research Group (GRAd), Neuroscience Research Program, Hospital del Mar Research Institute, Spain; School of Medicine, Universitat de Vic-Central de Catalunya (UCC), Spain.
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Daehn D, Meyer C, Loew V, Wabiszczewicz J, Pohl S, Böttche M, Pawils S, Renneberg B. Smartphone-based intervention for postpartum depressive symptoms (Smart-e-Moms): study protocol for a randomized controlled trial. Trials 2024; 25:469. [PMID: 38987846 PMCID: PMC11234544 DOI: 10.1186/s13063-024-08304-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 06/28/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Postpartum depression constitutes a significant public health issue, with prevalence rates ranging between 8 and 19% in high-income nations. Nevertheless, numerous barriers, including time constraints, societal stigmatization, and feelings of shame, contribute to the limited utilization of healthcare services during the postpartum period. Digital interventions offer an opportunity to enhance care for women experiencing postpartum depressive symptoms. METHODS We will conduct a two-arm randomized controlled trial to assess the effectiveness of a smartphone-based intervention in comparison to a treatment-as-usual control group in Germany. Our aim is to randomize 556 participants in a 1:1 ratio. Participants in the intervention group will be provided access to a preventive smartphone-based intervention called "Smart-e-Moms," which incorporates therapeutic support and comprises 10 concise modules rooted in cognitive-behavioral therapy. For the intervention group, evaluations will take place at baseline (t0), prior to sessions 4 and 8 (intermediate assessments), and upon completing the intervention 6 weeks after baseline (t1). The control group's assessments will be at baseline (t0) and 6 weeks after baseline. Follow-up assessments are scheduled at 12 and 24 weeks from baseline to examine the short-term stability of any observed effects. We anticipate that participants in the intervention group will exhibit improvements in their postpartum depressive symptoms (as measured with the Edinburgh Postnatal Depression Scale). Additionally, we will analyze secondary outcomes, including maternal bonding, stress levels, self-efficacy, satisfaction with the intervention, and healthcare utilization. DISCUSSION If Smart-e-Moms proves to be effective, it has the potential to play a significant role in postpartum depression care within German-speaking regions. Ideally, this intervention could not only benefit maternal well-being but also improve the prospects for healthy child development. TRIAL REGISTRATION German clinical trials registry DRKS00032324. Registered on January 26, 2024.
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Affiliation(s)
- Daria Daehn
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany.
| | - Caroline Meyer
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Viola Loew
- Department of Medical Psychology, University Medical Center Hamburg‑Eppendorf, Hamburg, Germany
| | | | - Steffi Pohl
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Maria Böttche
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Silke Pawils
- Department of Medical Psychology, University Medical Center Hamburg‑Eppendorf, Hamburg, Germany
| | - Babette Renneberg
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
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Qurat Ul Ain H, Junaid Tahir M, Abbasher Hussien Mohamed Ahmed K, Ahmed F, Mohamed Ibrahim Ali M, Hassan Salih Elhaj E, Mustafa GE, Ahsan A, Yousaf Z. Tele-stroke: a strategy to improve acute stroke care in low- and middle-income countries. Ann Med Surg (Lond) 2024; 86:3808-3811. [PMID: 38989217 PMCID: PMC11230807 DOI: 10.1097/ms9.0000000000002187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 05/08/2024] [Indexed: 07/12/2024] Open
Affiliation(s)
| | | | | | | | | | | | | | - Areeba Ahsan
- Foundation University School of Health Sciences, Islamabad, Pakistan
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Zhu L, Xing Y, Jia H, Xu W, Wang X, Ding Y. Effects of telehealth interventions on the caregiver burden and mental health for caregivers of people with dementia: a systematic review and meta-analysis. Aging Ment Health 2024:1-13. [PMID: 38946249 DOI: 10.1080/13607863.2024.2371480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 06/16/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVES To systematically evaluate the effects of telehealth interventions on the caregiver burden and mental health of caregivers for people with dementia (PWD). METHOD Relevant randomized controlled trials (RCTs) of telehealth interventions on caregivers were extracted from nine electronic databases (PubMed, The Cochrane Library, Web of Science, Embase, CINAHL, SinoMed, CNKI, WanFang, and VIP). The retrieval time was from inception to 26 July 2023. RESULTS Twenty-two articles with 2132 subjects were included in the final analysis. The meta-analysis demonstrated that telehealth interventions exerted a significant effect in reducing caregiver burden (SMD: -0.14, 95 % CI: -0.25, -0.02, p = 0.02), depression (SMD = -0.17; 95%CI: -0.27, -0.07, p < 0.001) and stress (SMD = -0.20, 95%CI: -0.37, -0.04, p = 0.01). However, no statistically significant effect was observed on anxiety (SMD = -0.12, 95%CI: -0.27, 0.03, p = 0.12). Moreover, subgroup analysis showed that tailored interventions were associated with more evident reductions in depression (SMD = -0.26; 95%CI: -0.40, -0.13, p < 0.001) than standardized interventions (SMD = -0.08; 95%CI: -0.22, 0.06, p = 0.25). In addition, telehealth was effective in relieving depression in Internet-based (SMD = -0.17, 95%CI: -0.30, -0.03, p = 0.01) and Telephone-based group (SMD = -0.18, 95%CI: -0.34, -0.02, p = 0.03), while there was no significant difference in the Internet and Telephone-based group (SMD = -0.18, 95%CI: -0.54, 0.18, p = 0.32). CONCLUSION Telehealth could effectively reduce the burden and relieve the depression and stress of caregivers of PWD, while its effect on anxiety requires further research. Overall, telehealth has potential benefits in dementia care.
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Affiliation(s)
- Ling Zhu
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Yurong Xing
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Hongfei Jia
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Wenhui Xu
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Xiaoxiao Wang
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Yaping Ding
- School of Nursing, Nanjing Medical University, Nanjing, China
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Lau Y, Chew HSJ, Ang WHD, Ang WW, Yeo CY, Lim GZQ, Wong SH, Lau ST, Cheng LJ. Effects of digital health interventions on the psychological outcomes of perinatal women: umbrella review of systematic reviews and meta-analyses. Health Psychol Rev 2024; 18:229-254. [PMID: 36919443 DOI: 10.1080/17437199.2023.2185654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/15/2023] [Indexed: 03/16/2023]
Abstract
Evidence about the effects of digital health interventions (DHIs) on the psychological outcomes of perinatal women is increasing but remains inconsistent. An umbrella review was conducted to (1) assess the effect of DHIs on depressive, anxiety and stress symptoms and (2) compare the effects of DHIs on different digital platforms and population natures. Ten databases were searched from inception until December 23, 2022. The Hartung-Knapp-Sidik-Jonkman random-effects meta-analyses were utilised. Methodological quality was evaluated using the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2). Twenty-four systematic reviews with 41 meta-analyses involving 45,509 perinatal women from 264 primary studies were included. The credibility of the evidence of meta-analyses was rated as highly suggestive (4.88%), suggestive (26.83%), weak (51.22%) or non-significant (17.07%) according to AMSTAR-2. Our findings suggest that DHIs are beneficial for reducing stress symptoms. However, conflicting effects were found on anxiety symptoms. Subgroup and meta-regression analyses suggested that DHIs effectively improve depressive symptoms in postnatal women, and DHIs using the website platform are highly effective in stress reduction. DHIs can be implemented adjuvant to usual obstetric care to improve depressive and stress symptoms. Additional well-designed RCTs with long-term follow-up are warranted.
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Affiliation(s)
- Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Han Shi Jocelyn Chew
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wei How Darryl Ang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wen Wei Ang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chin Yi Yeo
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Grace Zhi Qi Lim
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Siew Tiang Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ling Jie Cheng
- Health Systems and Behavioural Science Domain, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Xie H, Cong S, Wang R, Sun X, Han J, Ni S, Zhang A. Effect of eHealth interventions on perinatal depression: A meta-analysis. J Affect Disord 2024; 354:160-172. [PMID: 38490593 DOI: 10.1016/j.jad.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 02/29/2024] [Accepted: 03/09/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Perinatal depression (PND) is a common mental health problem, and eHealth interventions may provide a strategy for alleviating PND. AIM This meta-analysis aimed to determine the effect of eHealth interventions on PND. METHODS Six databases were searched to retrieve published randomized controlled trials (RCTs) on the effect of eHealth interventions on PND. A meta-analysis was performed on the data of these studies using a random effects model. RESULTS A total of 21 RCTs were included in the meta-analysis, which revealed that eHealth interventions significantly reduced antenatal depression (WMD = -1.64, 95 % CI [-2.92, -0.35], P = .013), postpartum depression (SMD = -0.41, 95 % CI [-0.52, -0.29], P < .001), anxiety (SMD = -0.39, 95 % CI [-0.51, -0.28], P < .001), stress (WMD = -2.93, 95 % CI [-4.58, -1.27], P = .001), and improved self-efficacy (SMD = 0.42, 95 % CI [0.21, 0.63], P < .001) compared with the control group. However, eHealth interventions did not significantly improve social support (SMD = 0.27, 95 % CI [-0.01, 0.56], P = .058). For antenatal depression, significant subgroup differences were observed in the digital platform and material presentation format. In addition, for postpartum depression, significant subgroup differences were found in the type of therapy. CONCLUSIONS The meta-analysis results suggest that eHealth interventions can relieve depression, anxiety, and stress symptoms and improve self-efficacy in perinatal women. However, these interventions did not improve social support. Additional high-quality studies on eHealth interventions in PND are needed to validate these results.
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Affiliation(s)
- Hongyan Xie
- School of Nursing, Nanjing Medical University, Jiangsu, China
| | - Shengnan Cong
- Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Jiangsu, China
| | - Rui Wang
- Central South University Xiangya School of Nursing, Hunan, China
| | - Xiaoqing Sun
- Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
| | - Jingjing Han
- School of Nursing, Suzhou University, Jiangsu, China
| | - Shiqian Ni
- School of Nursing, Nanjing Medical University, Jiangsu, China
| | - Aixia Zhang
- Women's Hospital of Nanjing Medical University, Nanjing Women and Children's Healthcare Hospital, Jiangsu, China.
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Lawrence CG, Breau G, Yang L, Hellerstein OS, Hippman C, Kennedy AL, Ryan D, Shulman B, Brotto LA. Effectiveness of a web-enabled psychoeducational resource for postpartum depression and anxiety among women in British Columbia. Arch Womens Ment Health 2024:10.1007/s00737-024-01468-8. [PMID: 38709329 DOI: 10.1007/s00737-024-01468-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/23/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE Postpartum depression (PPD) and anxiety (PPA) affect nearly one-quarter (23%) of women in Canada. eHealth is a promising solution for increasing access to postpartum mental healthcare. However, a user-centered approach is not routinely taken in the development of web-enabled resources, leaving postpartum women out of critical decision-making processes. This study aimed to evaluate the effectiveness, usability, and user satisfaction of PostpartumCare.ca, a web-enabled psychoeducational resource for PPD and PPA, created in partnership with postpartum women in British Columbia. METHODS Participants were randomized to either an intervention group (n = 52) receiving access to PostpartumCare.ca for four weeks, or to a waitlist control group (n = 51). Measures evaluating PPD (Edinburgh Postnatal Depression Scale) and PPA symptoms (Perinatal Anxiety Screening Scale) were completed at baseline, after four weeks, and after a two-week follow-up. User ratings of website usability and satisfaction and website metrics were also collected. RESULTS PPD and PPA symptoms were significantly reduced for the intervention group only after four weeks, with improvements maintained after a two-week follow-up, corresponding with small-to-medium effect sizes (PPD: partial η2 = 0.03; PPA: partial η2 = 0.04). Intervention participants were also more likely than waitlist controls to recover from clinical levels of PPD symptoms (χ 2 (1, n = 63) = 4.58, p = .032) and PostpartumCare.ca's usability and satisfaction were rated favourably overall. CONCLUSION Findings suggest that a web-enabled psychoeducational resource, created in collaboration with patient partners, can effectively reduce PPD and PPA symptoms, supporting its potential use as a low-barrier option for postpartum women. TRIAL REGISTRATION Protocol for this trial was preregistered on NIH U.S. National Library of Medicine, ClinicalTrials.gov as of May 2022 (ID No. NCT05382884).
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Affiliation(s)
- Claire G Lawrence
- Women's Health Research Institute, BC Women's Hospital + Health Centre, Vancouver, BC, Canada
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Genevieve Breau
- School of Human Sciences, Faculty of Education, Health, and Human Sciences, University of Greenwich, Old Royal Naval College, Park Row, London, SE10 9LS, UK.
| | - Lily Yang
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Orli S Hellerstein
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Catriona Hippman
- Women's Health Research Institute, BC Women's Hospital + Health Centre, Vancouver, BC, Canada
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
- Reproductive Mental Health Program, BC Women's Hospital + Health Centre, Vancouver, BC, Canada
| | - Andrea L Kennedy
- Reproductive Mental Health Program, BC Women's Hospital + Health Centre, Vancouver, BC, Canada
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Deirdre Ryan
- Reproductive Mental Health Program, BC Women's Hospital + Health Centre, Vancouver, BC, Canada
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Barbara Shulman
- Reproductive Mental Health Program, BC Women's Hospital + Health Centre, Vancouver, BC, Canada
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Lori A Brotto
- Women's Health Research Institute, BC Women's Hospital + Health Centre, Vancouver, BC, Canada
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Arifin SRM, Kamaruddin A, Muhammad NA, Nurumal MS, Mohadis HM, Hussain NHN, Wardaningsih S. An evaluation of digital intervention for perinatal depression and anxiety: A systematic review. AIMS Public Health 2024; 11:499-525. [PMID: 39027400 PMCID: PMC11252571 DOI: 10.3934/publichealth.2024025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/18/2024] [Accepted: 04/01/2024] [Indexed: 07/20/2024] Open
Abstract
Digital intervention has been shown to be helpful in improving perinatal mental health. However, the design characteristics of such interventions have not been systematically reviewed. Considering that a lack of support-especially from a partner-is one of the major contributing factors to perinatal depression and anxiety, it is crucial to determine whether digital interventions have included partner participation. In this review, we systematically examined the design characteristics of digital interventions related to perinatal depression and anxiety and aimed to determine whether partner participation was incorporated as part of the interventions. Based on the PRISMA 2020 guidelines, five databases (PubMed, EBSCO, Cochrane, ProQuest, and Scopus) were searched. Narrative results of design characteristics were developed to provide a framework for the design and evaluation of the studies. A total of 12 intervention studies from China, Sweden, Australia, New Zealand, Singapore, Norway, and the United Kingdom were included. Across all studies, internet cognitive behavioral therapy and mindfulness therapy were overwhelmingly utilized as the major intervention approaches. While all studies reported reduced depressive symptoms after the intervention, only four studies reported subsequent decreased levels of both depressive and anxiety symptoms. Only one study included partner support in the intervention. Cognitive behavioral therapy and mindfulness therapy, two of the most common intervention approaches, were found to be effective in alleviating perinatal depression and anxiety. Partner participation should be prioritized in designing digital interventions to ensure comprehensive and easily accessible social support for persons in need.
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Affiliation(s)
| | | | | | | | - Hazwani Mohd Mohadis
- Kulliyyah of Information and Communication Technology, International Islamic University Malaysia
| | | | - Shanti Wardaningsih
- Universitas Muhammadiyah Yogyakarta, Kampus Terpadu UMY, JI. Brawijaya, Kasihan, Bantul, Yogyakarta, Indonesia
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Ronen K, Gewali A, Dachelet K, White E, Jean-Baptiste M, Evans YN, Unger JA, Tandon SD, Bhat A. Acceptability and Utility of a Digital Group Intervention to Prevent Perinatal Depression in Youths via Interactive Maternal Group for Information and Emotional Support (IMAGINE): Pilot Cohort Study. JMIR Form Res 2024; 8:e51066. [PMID: 38306159 PMCID: PMC10873795 DOI: 10.2196/51066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/10/2023] [Accepted: 12/12/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Perinatal depression (depression during pregnancy or the first year postpartum) affects 10%-25% of perinatal individuals, with a higher risk among youths aged <25 years. The Mothers and Babies Course (MB) is an evidence-based intervention for the prevention of perinatal depression, grounded in cognitive behavioral therapy, attachment theory, and psychoeducation. OBJECTIVE We developed a digital adaptation of MB (Interactive Maternal Group for Information and Emotional Support [IMAGINE]) and evaluated it in a pre-post mixed methods pilot among young perinatal people in the United States. METHODS IMAGINE was a structured digital group of up to 7 participants, with scheduled MB content and open discussion for 12 weeks, facilitated by a social worker. Scheduled content included asynchronous SMS text messages, graphics, prerecorded videos, mood polls, and optional weekly synchronous video calls. Eligible participants were pregnant or ≤80 days postpartum, aged 16 to 24 years, had access to a smartphone, spoke English, and had a Patient Health Questionnaire score <10. Participants were recruited throughout the United States from August 2020 to January 2021 through paid social media ads, in-person outreach at clinics, and respondent-driven sampling. Participants completed quantitative questionnaires at enrollment and 3 months, and qualitative interviews at 3 months. We determined uptake, acceptability (by Acceptability of Intervention Measure score), and utility (by use of cognitive behavioral therapy skills). We compared depression symptoms (by Patient Health Questionnaire score), social support (by abbreviated Social Support Behavior score), and perceived stress (by Perceived Stress Score) between enrollment and follow-up by paired 2-tailed t test. RESULTS Among 68 individuals who contacted this study, 22 were screened, 13 were eligible, and 10 enrolled, for an uptake of 76.9%. Furthermore, 4 (40%) participants were pregnant at enrollment. Participants had a median age of 17.9 (IQR 17.4-21.7) years, 6 (67%) identified as Black, 5 (56%) Latinx, and 6 (67%) using Medicaid health insurance. Further, 9 (90%) participants completed follow-up. Among these, the mean acceptability score was 4.3 out of 5 (SD 0.6) and all participants said they would recommend IMAGINE to a friend. Participants reported using a median of 7 of 11 skills (IQR 5-7 skills) at least half the days. We found no significant changes in depression symptoms, perceived stress, or social support. Qualitatively, participants reported one-to-one support from the facilitator, connection with other parents, and regular mood reflection were especially helpful aspects of the intervention. Additionally, participants reported that the intervention normalized their mental health challenges, improved their ability to manage their mood, and increased their openness to mental health care. CONCLUSIONS This pilot study provides promising evidence of the acceptability and utility of IMAGINE among perinatal youths. Our study's small sample size did not detect changes in clinical outcomes; our findings suggest IMAGINE warrants larger-scale evaluation.
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Affiliation(s)
- Keshet Ronen
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Anupa Gewali
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Kristin Dachelet
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Erica White
- Department of Global Health, University of Washington, Seattle, WA, United States
| | | | - Yolanda N Evans
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, United States
| | - Jennifer A Unger
- Department of Obstetrics and Gynecology, Warren Alpert Medical School at Brown University, Providence, RI, United States
| | - S Darius Tandon
- Department of Medical Social Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, United States
- Center for Community Health, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Amritha Bhat
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
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Flowers D, Goodspeed E, Daly M. Telehealth as an Effective Care Delivery Method During the COVID-19 Pandemic for the Rhode Island Behavioral Health Population. Community Ment Health J 2024; 60:108-114. [PMID: 37737526 DOI: 10.1007/s10597-023-01187-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 09/07/2023] [Indexed: 09/23/2023]
Abstract
In response to the COVID-19 pandemic, Rhode Island implemented a telehealth waiver allowing telehealth parity. This study investigated (1) if telehealth allowed for patients who seek mental health services to maintain visit frequency and (2) if subpopulations were less likely to utilize telehealth. We used descriptive statistics to analyze the change in total number of visits, in-person visits from pre-waiver to post-waiver, and a multivariate linear regression to identify relationships between demographics and telehealth utilization. Participants were able to maintain the frequency of visits during the COVID-19 pandemic. Race/ethnicity, age, gender, employment status, and housing status were all statistically significant predictors of telehealth utilization. Telehealth aids in the continuing of care when in-person visits are not a viable option. Access to telehealth is crucial during public health emergencies and aids in maintaining visit frequency. Further research should be done to evaluate subgroups who are less likely to utilize telehealth.
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Affiliation(s)
- Demetria Flowers
- Department of Behavioral Health, Developmental Disabilities and Hospitals, State of Rhode Island, Cranston, RI, 02904, USA.
| | - Emily Goodspeed
- Department of Behavioral Health, Developmental Disabilities and Hospitals, State of Rhode Island, Cranston, RI, 02904, USA
| | - Mackenzie Daly
- Department of Behavioral Health, Developmental Disabilities and Hospitals, State of Rhode Island, Cranston, RI, 02904, USA
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Yang M, Song B, Jiang Y, Lin Y, Liu J. Mindfulness-Based Interventions for Postpartum Depression: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2023; 52:2496-2505. [PMID: 38435783 PMCID: PMC10903316 DOI: 10.18502/ijph.v52i12.14311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/19/2023] [Indexed: 03/05/2024]
Abstract
Background We aimed to investigate the intervention effect of mindfulness-based interventions (MBIs) in patients with postpartum depression. Methods The method of computer and manual keyword retrieval was used to search PubMed, Web of Science, Cochrane Library. Literature included in the study was assessed for quality and meta-analysis was performed using RevMan 5.3 software. Results Twelve articles were finally included in the study and the meta-analysis showed that 6 articles used the Edinburgh Postnatal Depression Scale (EPDS) to compare MBIs with conventional therapy, and the statistical heterogeneity between the combined results was low (P=0.18, I2=32%). The level of depression in postpartum depression patients was lower in the MBIs group than in the conventional group [MD=3.13, 95%CI (2.57, 3.70), P<0.00001]. Based on the Beck Depression Inventory (BDI), the comparison between MBIs and conventional therapy had low statistical heterogeneity between the combined results (P=0.56, I2=0%). The level of depression in patients with postpartum depression who received MBIs was significantly lower than in the conventional care group [MD=5.89, 95%CI (4.88, 6.91), P<0.00001]. Subgroup analysis showed that the best intervention duration for MBIs for postpartum depression was within 4 weeks (SMD=-1.785), each session ≦60 minutes (SMD=-1.435), and participants had to complete the best three times per week (SMD=-2.185). Conclusion MBIs can alleviate depression in women, thereby facilitating their adjustment to new life. It is recommended to practice mindfulness meditation for 30 minutes per day.
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Affiliation(s)
- Miaoxiong Yang
- Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China
| | - Baozhi Song
- Department of Gynecology, Shengli Clinical Medical College of Fujian Medical University & Fujian Provincial Hospital, Fuzhou 350001, China
| | - Yatao Jiang
- Department of Obstetrics, Shengli Clinical Medical College of Fujian Medical University & Fujian Provincial Hospital, Fuzhou 350001, China
| | - Ying Lin
- Department of Pathology, Shengli Clinical Medical College of Fujian Medical University & Fujian Provincial Hospital, Fuzhou 350001, China
| | - Jiahua Liu
- Department of Gynecology, Shengli Clinical Medical College of Fujian Medical University & Fujian Provincial Hospital, Fuzhou 350001, China
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Salameh TN, Nyakeriga DB, Hall LA. Telehealth Care for Perinatal Depression in Immigrant and Refugee Women: A Scoping Review. Issues Ment Health Nurs 2023; 44:1216-1225. [PMID: 37832145 DOI: 10.1080/01612840.2023.2258222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
Immigrant and refugee women have higher rates of perinatal depression compared to native-born women. Innovative telehealth interventions provide opportunities for prevention and treatment of perinatal depression. However, little is known about telehealth for perinatal immigrant and refugee women with depression. The aims of this scoping review were to identify available literature addressing the use of telehealth care for perinatal depression in immigrant and refugee women, and to determine the content, mode of delivery, and outcomes of telehealth care when provided for this population. A systematic literature search from 2000 to July 2023 was conducted in six databases and grey literature. The initial search resulted in 988 articles which were screened for their titles and abstracts. Eighty-one full-text articles were reviewed, yielding five articles included in this review. One quantitative study (a feasibility descriptive study), three qualitative studies, and a commentary supported the user satisfaction and potential effectiveness of telehealth care, delivered via telephone and text messaging, in improving perinatal depression symptoms. This review revealed a dearth of data-based studies on the outcomes of telehealth care for perinatal depression among immigrant and refugee women. Collaboration among researchers, healthcare providers, and technology engineers is required to improve telehealth care for this population.
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Affiliation(s)
- Taghreed N Salameh
- School of Nursing Women's Health Department, Koç University, İstanbul, Turkey
| | | | - Lynne A Hall
- School of Nursing, University of Louisville, Louisville, Kentucky, USA
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Howard A, Wang S, Adachi J, Yadama A, Bhat A. Facilitators of and barriers to perinatal telepsychiatry care: a qualitative study. BMJ Open 2023; 13:e071084. [PMID: 37802623 PMCID: PMC10565296 DOI: 10.1136/bmjopen-2022-071084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVES Perinatal mental health disorders such as anxiety, depression and bipolar disorder can negatively impact the health of women and their children without appropriate detection and treatment. Due to increases in mental health symptoms and transmission risks associated with in-person appointments, many clinics transitioned to providing telepsychiatry care during the COVID-19 pandemic. This study sought to identify the facilitators and barriers to receiving perinatal telepsychiatry care from the perspective of patients, clinic staff and psychiatrists. DESIGN Qualitative study based on analysis of in depth semistructured interviews. SETTING The study was conducted in a virtual specialty mental health clinic in an academic setting. PARTICIPANTS Eight patients who had been scheduled for an appointment with the perinatal telepsychiatry clinic between 14 May 2021 and 1 August 2021, seven of whom had attended their scheduled appointment with the clinic and one of whom had not, and five staff members including psychiatrists, navigators and clinic managers, participated in in-depth interviews. RESULTS Telepsychiatry was perceived by most as preferable to in-person care and easy to attend and navigate. Alternatively, technological difficulties, personal preference for in-person care and scheduling conflicts related to the perinatal period were identified as barriers by some. Participants identified communication between care staff and patients, online patient portals, and appointment reminders as important for facilitating appointment preparedness and attendance. CONCLUSIONS The findings from this study suggest that telepsychiatry services are perceived positively by patients and care staff and have the potential to improve access to mental healthcare for perinatal patients.
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Affiliation(s)
- Anna Howard
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Sunny Wang
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
| | - Jamie Adachi
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Alexa Yadama
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Amritha Bhat
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
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Alcântara TDS, Carvalho GAC, Sanchez JM, Ramos SF, Cunha LC, Araújo-Neto FDC, Valença-Feitosa F, Silvestre CC, Lyra Junior DPD. Quality indicators of hospitalized children influenced by clinical pharmacist services: A systematic review. Res Social Adm Pharm 2023; 19:1315-1330. [PMID: 37442709 DOI: 10.1016/j.sapharm.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 05/31/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Care for children who are hospitalized can be optimized if the pharmacist, in conjunction with the multidisciplinary team, promotes the rational use of medicines. In this sense, the evaluation of the quality of these clinical services through indicators is important in the planning, decision making of pharmacists and managers of these services. OBJECTIVE To characterize which health indicators were influenced by the pharmaceutical clinical services for the care of children in hospitals. METHODS A systematic review was performed. The search for data was made on the bases: Cochrane, Embase, Lilacs, Pubmed and Web of Science. Then, the search included studies in which evaluated the impact of pharmaceutical clinical services on clinical, economic and humanistic outcomes. RESULTS The search resulted in 11 included studies. In this review, four pharmaceutical clinical services were found: pharmacotherapy review, multiprofessional team interventions, antimicrobial stewardship program and pharmaceutical services at discharge hospital. The most influenced outcome indicators were length of hospital stay, with average time in the group that received the pharmacotherapy review service, and interventions multiprofessional team with a 6.45-day vs. 10.83 days in the control group; hospital readmissions with a significant reduction of non-scheduled readmission of 30 days in the ntimicrobial stewardship program; reduction of hospital costs and caregiver satisfaction. CONCLUSION In this study, we can highlight that pharmacotherapy review, multiprofessional team interventions and Antimicrobial Stewardship Program that significantly reduced the clinical results of length of hospital stay and hospital readmission, as well as a significant reduction of hospital costs.
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Affiliation(s)
- Thaciana Dos Santos Alcântara
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | | | - Júlia Mirão Sanchez
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Sheila Feitosa Ramos
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | - Luiza Correia Cunha
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | - Fernando de Castro Araújo-Neto
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | - Fernanda Valença-Feitosa
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | - Carina Carvalho Silvestre
- Department of Pharmacy, Life Sciences Institute, Federal University of Juiz de Fora, Campus Governador Valadares, Brazil.
| | - Divaldo Pereira de Lyra Junior
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
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Link K, Christians S, Hoffmann W, Grabe HJ, van den Berg N. Telemedicine treatment of patients with mental disorders during and after the first COVID-19 pandemic lockdown in Germany - an observational study on feasibility and patient satisfaction. BMC Psychiatry 2023; 23:654. [PMID: 37670236 PMCID: PMC10478407 DOI: 10.1186/s12888-023-05140-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 08/25/2023] [Indexed: 09/07/2023] Open
Abstract
INTRODUCTION In response to the COVID-19 pandemic, a general lockdown was enacted across Germany in March 2020. As a consequence, patients with mental health conditions received limited or no treatment in day hospitals and outpatient settings. To ensure continuity of care, the necessary technological preparations were made to enable the implementation of telemedical care via telephone or video conferencing, and this option was then used as much as possible. The aim of this study was to investigate the satisfaction and acceptance with telemedical care in a heterogeneous patient group of psychiatric outpatients in Germany during the first COVID-19 lockdown. METHODS In this observational study, patients in ongoing or newly initiated outpatient psychiatric therapy as well as those who had to be discharged from the day clinic ahead of schedule received telemedical treatment via telephone. Data collection to assess the patients' and therapists' satisfaction with and acceptance of the telemedical care was adjusted to the treatment setting. RESULTS Of 60 recruited patients, 57 could be included in the analysis. 51.6% of the patients and 52.3% of their therapists reported that the discussion of problems and needs worked just as well over the phone as in face-to-face consultations. In the subgroup of patients who were new to therapy due to being discharged from hospital early, acceptance was higher and telemedicine was rated as equally good in 87.5% of contacts. Both patients and therapists felt that telemedicine care during lockdown was an alternative for usual therapy in the outpatient clinic and that the option of telemedicine care should continue for the duration of the coronavirus pandemic. DISCUSSION The results show a clear trend towards satisfaction with and acceptance of telemedicine care in a heterogeneous group of unselected psychiatric patients. Although the number of patients is small, the results indicate that the mostly positive results of telemedicine concepts in research projects can probably be transferred to real healthcare settings. CONCLUSIONS Telemedicine can be employed in healthcare for psychiatric patients either an alternative treatment option to maintain continuity of care or as a potential addition to regular care.
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Affiliation(s)
- Karsten Link
- Institut Für Community Medicine, Universitätsmedizin Greifswald, Ellernholzstraße 1-2, 17475, Greifswald, Germany.
| | - Svenja Christians
- Klinik Und Poliklinik Für Psychiatrie Und Psychotherapie, Universitätsmedizin Greifswald, Ellernholzstraße 1-2, 17475, Greifswald, Germany
| | - Wolfgang Hoffmann
- Institut Für Community Medicine, Universitätsmedizin Greifswald, Ellernholzstraße 1-2, 17475, Greifswald, Germany
| | - Hans Jörgen Grabe
- Klinik Und Poliklinik Für Psychiatrie Und Psychotherapie, Universitätsmedizin Greifswald, Ellernholzstraße 1-2, 17475, Greifswald, Germany
| | - Neeltje van den Berg
- Institut Für Community Medicine, Universitätsmedizin Greifswald, Ellernholzstraße 1-2, 17475, Greifswald, Germany
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16
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Chung SY. Delivery of healthcare and healthcare education in the digital era and beyond: opportunities and considerations. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2023; 29:153-159. [PMID: 37813659 PMCID: PMC10565527 DOI: 10.4069/kjwhn.2023.09.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/21/2023] [Accepted: 09/06/2023] [Indexed: 10/11/2023] Open
Affiliation(s)
- Seon Yoon Chung
- College of Nursing, University of Wisconsin Oshkosh, WI, USA
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17
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Melov SJ, Galas N, Swain J, Alahakoon TI, Lee V, Cheung NW, McGee T, Pasupathy D, McNab J. Women's experience of perinatal support in a high migrant Australian population during the COVID-19 pandemic: a mixed methods study. BMC Pregnancy Childbirth 2023; 23:429. [PMID: 37296421 DOI: 10.1186/s12884-023-05745-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND As a COVID-19 risk mitigation measure, Australia closed its international borders for two years with significant socioeconomic disruption including impacting approximately 30% of the Australian population who are migrants. Migrant populations during the peripartum often rely on overseas relatives visiting for social support. High quality social support is known to lead to improved health outcomes with disruption to support a recognised health risk. AIM To explore women's experience of peripartum social support during the COVID-19 pandemic in a high migrant population. To quantify type and frequency of support to identify characteristics of vulnerable perinatal populations for future pandemic preparedness. METHODS A mixed methods study with semi-structured interviews and a quantitative survey was conducted from October 2020 to April 2021. A thematic approach was used for analysis. RESULTS There were 24 participants interviewed both antenatally and postnatally (22 antenatal; 18 postnatal). Fourteen women were migrants and 10 Australian born. Main themes included; 'Significant disruption and loss of peripartum support during the COVID-19 pandemic and ongoing impact for migrant women'; 'Husbands/partners filling the support gap' and 'Holding on by a virtual thread'. Half of the participants felt unsupported antenatally. For Australian born women, this dissipated postnatally, but migrants continued to feel unsupported. Migrant women discussed partners stepped into traditional roles and duties of absent mothers and mothers-in-law who were only available virtually. CONCLUSION This study identified disrupted social support for migrant women during the pandemic, providing further evidence that the pandemic has disproportionately impacted migrant populations. However, the benefits identified in this study included high use of virtual support, which could be leveraged for improving clinical care in the present and in future pandemics. The COVID-19 pandemic impacted most women's peripartum social support with migrant families having ongoing disruption. Gains in the pandemic included greater gender equity for domestic work as husbands/partners increased their contribution to domestic work and childcare.
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Affiliation(s)
- Sarah J Melov
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- Westmead Institute for Maternal and Fetal Medicine, Research and Education Building, Crn Hawkesbury and Darcy Rd, Westmead, NSW, 2145, Australia.
| | - Nelma Galas
- Women's and Newborn Health, Westmead Hospital, Sydney, NSW, Australia
| | - Julie Swain
- Women's and Newborn Health, Westmead Hospital, Sydney, NSW, Australia
| | - Thushari I Alahakoon
- Westmead Institute for Maternal and Fetal Medicine, Research and Education Building, Crn Hawkesbury and Darcy Rd, Westmead, NSW, 2145, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Vincent Lee
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Renal Medicine, Westmead Hospital, Sydney, NSW, Australia
| | - N Wah Cheung
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Diabetes & Endocrinology, Westmead Hospital, Sydney, Australia
| | - Therese McGee
- Women's and Newborn Health, Westmead Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Dharmintra Pasupathy
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Westmead Institute for Maternal and Fetal Medicine, Research and Education Building, Crn Hawkesbury and Darcy Rd, Westmead, NSW, 2145, Australia
| | - Justin McNab
- Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
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18
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Zheng Z, Li C, Xie RH, Xie H, Fu F, Pan Y, Liao J, Chen X, Yue L. Effectiveness of telehealth interventions on depression symptoms after stroke: A systematic review and meta-analysis. J Affect Disord 2023:S0165-0327(23)00730-9. [PMID: 37247784 DOI: 10.1016/j.jad.2023.05.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Depression symptoms are common after stroke, and affect survivors' recovery of neurological function, ability to return to society, and quality of life. Telehealth has been shown to improve depression symptoms and quality of life among patients post-stroke. However, evidence from clinical trials has not previously been systematically synthesized. OBJECTIVE This study aimed to systematically evaluate the effectiveness of telehealth interventions in reducing depression symptoms among patients post-stroke. METHODS Following the PRISMA guidelines, we conducted a meta-analysis of randomized control trials of telehealth interventions for post-stroke depression symptoms. The quality of included studies was assessed using the Cochrane risk of bias tool. RevMan 5.4 software was used for the meta-analysis. Data were synthesized by fixed (I2 ≤ 50 %) or random (I2 > 50 %) effects models based on a heterogeneity test. RESULTS In total, 10 studies with 1717 participants were included, eight of which were eligible for the meta-analysis. There were no significant differences in efficacy between the telehealth and control groups for depression symptoms (standardized mean difference [SMD] = -0.16, 95 % confidence interval [CI] -0.67 to 0.36; P = .54), quality of life (SMD = 0.00, 95%CI -0.18 to 0.18; P = .99), limb function (SMD = 0.46, 95%CI -0.26 to 1.18; P = .21), and daily living ability (SMD = 0.38, 95%CI -1.39 to 2.15; P = .67). The telemedicine group had significantly lower anxiety scores than the control group (SMD = -1.05, 95%CI -1.22 to -0.89; P < .001). LIMITATIONS The number of RCTs included in the review was relatively small. CONCLUSIONS The efficacy of telehealth interventions in reducing depression symptoms in patients post-stroke is no different from conventional nursing. However, large-scale, high-quality randomized controlled trials are needed to further explore the potential of telehealth interventions in improving mental health among patients post-stroke.
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Affiliation(s)
- Zhimin Zheng
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Chunxia Li
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Ri-Hua Xie
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China; Department of Nursing, The Seventh Affiliated Hospital, Southern Medical University, Foshan, China
| | - Hualing Xie
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Fen Fu
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yuhua Pan
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jinyu Liao
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xiaoying Chen
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Liqun Yue
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.
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Chen C, Wang X, Xu H, Li Y. Effectiveness of digital psychological interventions in reducing perinatal depression: a systematic review of meta-analyses. Arch Womens Ment Health 2023:10.1007/s00737-023-01327-y. [PMID: 37231116 DOI: 10.1007/s00737-023-01327-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023]
Abstract
Digital psychological interventions have been widely used clinically in recent years, but the methodological quality and quality of evidence of related studies are unclear, thus interfering with the translation of practice outcomes and the application of clinical decisions. We searched for meta-analyses of randomized controlled trials in the PubMed, Web of Science, Embase, Cochrane Library, JBI Database, CINAHL, and PsycINFO databases as well as some databases containing gray literature up to 27 April 2022 using a combination of keywords. After two researchers independently screened and extracted data from the literature, the methodological quality of the included literature was evaluated by the AMSTAR 2 scale, and the evidence quality of the outcome index was graded by the Grading of Recommendations, Assessment, Development, and Evaluation system. A total of 12 meta-analyses reporting the positive impact of digital psychological interventions in the prevention and/or treatment of depressive symptoms in perinatal women were included, but the methodological quality and evidence level of the included studies were low. Digital psychological interventions are effective in reducing perinatal depression, but the methodological quality and reliability of outcome indicators are mostly low. Improving study designs, using higher-quality clinical evidence, conducting systematic evaluation studies strictly following the procedures, and standardizing the reporting of study results are recommended.
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Affiliation(s)
- Caifeng Chen
- College of Nursing, Anhui Medical University, Hefei, Anhui, China
| | - Xiaoying Wang
- College of Nursing, Anhui Medical University, Hefei, Anhui, China
| | - Han Xu
- College of Nursing, Anhui Medical University, Hefei, Anhui, China
| | - Yuhong Li
- College of Nursing, Anhui Medical University, Hefei, Anhui, China.
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20
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Stentzel U, Grabe HJ, Schmidt S, Tomczyk S, van den Berg N, Beyer A. Mental health-related telemedicine interventions for pregnant women and new mothers: a systematic literature review. BMC Psychiatry 2023; 23:292. [PMID: 37118689 PMCID: PMC10148488 DOI: 10.1186/s12888-023-04790-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 04/14/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Pregnancy and the postpartum period are times when women are at increased risk for depression and mental problems. This may also negatively affect the foetus. Thus, there is a need for interventions with low-threshold access and care. Telemedicine interventions are a promising approach to address these issues. This systematic literature review examined the efficacy of telemedicine interventions for pregnant women and/or new mothers to address mental health-related outcomes. The primary objective was to analyse whether telemedicine interventions can reduce mental health problems in pregnant women and new mothers. The secondary aim was to clarify the impact of type of interventions, their frequency and their targets. METHODS Inclusion criteria: randomized controlled trials, with participants being pregnant women and/or new mothers (with infants up to twelve months), involving telemedicine interventions of any kind (e.g. websites, apps, chats, telephone), and addressing any mental health-related outcomes like depression, postnatal depression, anxiety, stress and others. Search terms were pregnant women, new mothers, telemedicine, RCT (randomised controlled trials), mental stress as well as numerous synonyms including medical subject headings. The literature search was conducted within the databases PubMed, Cochrane Library, Web of Science and PsycINFO. Screening, inclusion of records and data extraction were performed by two researchers according to the PRISMA guidelines, using the online tool CADIMA. RESULTS Forty four articles were included. A majority (62%) reported significantly improved mental health-related outcomes for participants receiving telemedicine interventions compared to control. In particular (internet-delivered) Cognitive Behavioural Therapy was successful for depression and stress, and peer support improved outcomes for postnatal depression and anxiety. Interventions with preventive approaches and interventions aimed at symptom reduction were largely successful. For the most part there was no significant improvement in the symptoms of anxiety. CONCLUSION Telemedicine interventions evaluated within RCTs were mostly successful. However, they need to be designed to specifically target a certain mental health issue because there is no one-size-fits-all approach. Further research should focus on which specific interventions are appropriate for which mental health outcomes in terms of intervention delivery modes, content, target approaches, etc. Further investigation is needed, in particular with regard to anxiety.
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Affiliation(s)
- Ulrike Stentzel
- Institute for Community Medicine, University Medicine Greifswald, Section Epidemiology of Health Care and Community Health, Ellernholzstraße 1-2, 17489, Greifswald, Germany.
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Ellernholzstraße 1-2, 17489, Greifswald, Germany
| | - Silke Schmidt
- Department Health and Prevention, Institute of Psychology, University of Greifswald, Greifswald, Germany
| | - Samuel Tomczyk
- Department Health and Prevention, Institute of Psychology, University of Greifswald, Greifswald, Germany
| | - Neeltje van den Berg
- Institute for Community Medicine, University Medicine Greifswald, Section Epidemiology of Health Care and Community Health, Ellernholzstraße 1-2, 17489, Greifswald, Germany
| | - Angelika Beyer
- Institute for Community Medicine, University Medicine Greifswald, Section Epidemiology of Health Care and Community Health, Ellernholzstraße 1-2, 17489, Greifswald, Germany
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21
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Ahmed Kamal M, Ismail Z, Shehata IM, Djirar S, Talbot NC, Ahmadzadeh S, Shekoohi S, Cornett EM, Fox CJ, Kaye AD. Telemedicine, E-Health, and Multi-Agent Systems for Chronic Pain Management. Clin Pract 2023; 13:470-482. [PMID: 36961067 PMCID: PMC10037594 DOI: 10.3390/clinpract13020042] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/12/2023] [Accepted: 03/16/2023] [Indexed: 03/25/2023] Open
Abstract
Telemedicine, telehealth, and E-health all offer significant benefits for pain management and healthcare services by fostering the physician-patient relationship in otherwise challenging circumstances. A critical component of these artificial-intelligence-based health systems is the "agent-based system", which is rapidly evolving as a means of resolving complicated or straightforward problems. Multi-Agent Systems (MAS) are well-established modeling and problem-solving modalities that model and solve real-world problems. MAS's core concept is to foster communication and cooperation among agents, which are broadly considered intelligent autonomous factors, to address diverse challenges. MAS are used in various telecommunications applications, including the internet, robotics, healthcare, and medicine. Furthermore, MAS and information technology are utilized to enhance patient-centered palliative care. While telemedicine, E-health, and MAS all play critical roles in managing chronic pain, the published research on their use in treating chronic pain is currently limited. This paper discusses why telemedicine, E-health, and MAS are the most critical novel technologies for providing healthcare and managing chronic pain. This review also provides context for identifying the advantages and disadvantages of each application's features, which may serve as a useful tool for researchers.
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Affiliation(s)
| | - Zainab Ismail
- Faculty of Medicine, Menoufia University, Shiben El Kom 51123, Egypt
| | - Islam Mohammad Shehata
- Department of Anesthesiology, Faculty of Medicine, Ain Shams University, Cairo 11517, Egypt
| | - Soumia Djirar
- Department of Ophthalmology, University of Montreal, Montreal, QC H3T 1J4, Canada
| | - Norris C Talbot
- School of Medicine, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, USA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, USA
| | - Elyse M Cornett
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, USA
| | - Charles J Fox
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA 71103, USA
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22
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Roberts N, Carrigan A, Clay-Williams R, Hibbert PD, Mahmoud Z, Pomare C, Fajardo Pulido D, Meulenbroeks I, Knaggs GT, Austin EE, Churruca K, Ellis LA, Long JC, Hutchinson K, Best S, Nic Giolla Easpaig B, Sarkies MN, Francis Auton E, Hatem S, Dammery G, Nguyen MT, Nguyen HM, Arnolda G, Rapport F, Zurynski Y, Maka K, Braithwaite J. Innovative models of healthcare delivery: an umbrella review of reviews. BMJ Open 2023; 13:e066270. [PMID: 36822811 PMCID: PMC9950590 DOI: 10.1136/bmjopen-2022-066270] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE To undertake a synthesis of evidence-based research for seven innovative models of care to inform the development of new hospitals. DESIGN Umbrella review. SETTING Interventions delivered inside and outside of acute care settings. PARTICIPANTS Children and adults with one or more identified acute or chronic health conditions. DATA SOURCES PsycINFO, Ovid MEDLINE and CINAHL. PRIMARY AND SECONDARY OUTCOME MEASURES Clinical indicators and mortality, healthcare utilisation, quality of life, self-management and self-care and patient knowledge. RESULTS A total of 66 reviews were included, synthesising evidence from 1272 primary studies across the 7 models of care. Virtual care was the most common model studied, addressed by 47 (73%) of the reviews. Common outcomes evaluated across reviews were clinical indicators and mortality, healthcare utilisation, self-care and self-management, patient knowledge, quality of life and cost-effectiveness. The findings indicate that the innovative models of healthcare we identified in this review may be effective in managing patients with a range of acute and chronic conditions. Most of the included reviews reported evidence of comparable or improved care. CONCLUSIONS A consideration of local infrastructure and individual patient characteristics, such as health literacy, may be critical in determining the suitability of models of care for patients and their implementation in local health systems. TRIAL REGISTRATION NUMBER 10.17605/OSF.IO/PS6ZU.
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Affiliation(s)
- Natalie Roberts
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Ann Carrigan
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Peter D Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Zeyad Mahmoud
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- LEMNA, F-44000, Universite de Nantes, Nantes, France
| | - Chiara Pomare
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Diana Fajardo Pulido
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Isabelle Meulenbroeks
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Gilbert Thomas Knaggs
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Elizabeth E Austin
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Karen Hutchinson
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Stephanie Best
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Genomics, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Brona Nic Giolla Easpaig
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Mitchell N Sarkies
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Emilie Francis Auton
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Sarah Hatem
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Genevieve Dammery
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Mai-Tran Nguyen
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Hoa Mi Nguyen
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Gaston Arnolda
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Yvonne Zurynski
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Katherine Maka
- Western Sydney Local Health District, Wentworthville, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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23
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Xie EB, Freeman M, Penner-Goeke L, Reynolds K, Lebel C, Giesbrecht GF, Rioux C, MacKinnon A, Sauer-Zavala S, Roos LE, Tomfohr-Madsen L. Building Emotional Awareness and Mental Health (BEAM): an open-pilot and feasibility study of a digital mental health and parenting intervention for mothers of infants. Pilot Feasibility Stud 2023; 9:27. [PMID: 36800982 PMCID: PMC9938356 DOI: 10.1186/s40814-023-01245-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/13/2023] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND Maternal mental health concerns and parenting stress in the first few years following childbirth are common and pose significant risks to maternal and child well-being. The COVID-19 pandemic has led to increases in maternal depression and anxiety and has presented unique parenting stressors. Although early intervention is crucial, there are significant barriers to accessing care. METHODS To inform a larger randomized controlled trial, the current open-pilot trial investigated initial evidence for the feasibility, acceptability, and efficacy of a newly developed online group therapy and app-based mental health and parenting program (BEAM) for mothers of infants. Forty-six mothers 18 years or older with clinically elevated depression scores, with an infant aged 6-17 months old, and who lived in Manitoba or Alberta were enrolled in the 10-week program (starting in July 2021) and completed self-report surveys. RESULTS The majority of participants engaged in each of the program components at least once and participants indicated relatively high levels of app satisfaction, ease of use, and usefulness. However, there was a high level of attrition (46%). Paired-sample t-tests indicated significant pre- to post-intervention change in maternal depression, anxiety, and parenting stress, and in child internalizing, but not externalizing symptoms. Effect sizes were in the medium to high range, with the largest effect size observed for depressive symptoms (Cohen's d = .93). DISCUSSION This study shows moderate levels of feasibility and strong preliminary efficacy of the BEAM program. Limitations to program design and delivery are being addressed for testing in adequately powered follow-up trials of the BEAM program for mothers of infants. TRIAL REGISTRATION NCT04772677 . Registered on February 26 2021.
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Affiliation(s)
- E. Bailin Xie
- grid.22072.350000 0004 1936 7697Department of Psychology, University of Calgary, Calgary, AB Canada
| | - Makayla Freeman
- grid.17091.3e0000 0001 2288 9830Department of Educational and Counselling Psychology, and Special Education, University of British Columbia, Vancouver, BC Canada
| | - Lara Penner-Goeke
- grid.21613.370000 0004 1936 9609Department of Psychology, University of Manitoba, Winnipeg, MB Canada
| | - Kristin Reynolds
- grid.21613.370000 0004 1936 9609Department of Psychology, University of Manitoba, Winnipeg, MB Canada
| | - Catherine Lebel
- grid.413571.50000 0001 0684 7358Alberta Children’s Hospital Research Institute (ACHRI), Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Radiology, University of Calgary, Calgary, AB Canada
| | - Gerald F. Giesbrecht
- grid.22072.350000 0004 1936 7697Department of Psychology, University of Calgary, Calgary, AB Canada ,grid.413571.50000 0001 0684 7358Alberta Children’s Hospital Research Institute (ACHRI), Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Pediatrics, University of Calgary, Calgary, AB Canada
| | - Charlie Rioux
- grid.266900.b0000 0004 0447 0018Department of Psychology, University of Oklahoma, Norman, OK USA
| | - Anna MacKinnon
- grid.14848.310000 0001 2292 3357Department of Psychiatry and Addictology, Université de Montréal, Montréal, QC Canada ,grid.411418.90000 0001 2173 6322CHU Sainte-Justine Research Center, Montréal, QC Canada
| | - Shannon Sauer-Zavala
- grid.266539.d0000 0004 1936 8438Department of Psychology, University of Kentucky, Lexington, KY USA
| | - Leslie E. Roos
- grid.21613.370000 0004 1936 9609Department of Psychology, University of Manitoba, Winnipeg, MB Canada ,grid.460198.20000 0004 4685 0561Children’s Hospital Research Institute of Manitoba, Winnipeg, MB Canada
| | - Lianne Tomfohr-Madsen
- grid.17091.3e0000 0001 2288 9830Department of Educational and Counselling Psychology, and Special Education, University of British Columbia, Vancouver, BC Canada
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24
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Abstract
Telemental health-the use of videoconferencing or audio only (telephone) in mental health care-has accelerated tremendously since the start of the covid-19 pandemic. Meta-analyses have examined the reliability (ie, concordance) of assessment and the efficacy/effectiveness of telemental health compared with in-person care. Results indicate that telemental health assessment and clinical outcomes are similar compared with in-person care but there is much unexplained variability, as well as evidence that patient clinical and demographic characteristics can influence these findings. Further, gaps exist in the literature regarding specific patient populations (eg, psychotic disorders, children/adolescents), treatment modalities (eg, group therapy), audio only telemedicine, and hybrid care that mixes in-person with telemental health care. These gaps provide important directions for the next generation of telemental health research. Comprehensive clinical guidelines from mental health organizations are available to telemental health practitioners and focus on five content themes: legal and regulatory issues, clinical considerations, standard operating procedures and protocols, technical requirements, and considerations of specific populations and settings.
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Affiliation(s)
| | - Alisa B Busch
- McLean Hospital, Harvard Medical School, Belmont, MA
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25
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Smith KA, Howard LM, Vigod SN, D’Agostino A, Cipriani A. Perinatal mental health and COVID-19: Navigating a way
forward. Aust N Z J Psychiatry 2022:48674221137819. [PMID: 36440619 PMCID: PMC9708536 DOI: 10.1177/00048674221137819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The COVID-19 pandemic and its aftermath have increased pre-existing inequalities and risk factors for mental disorders in general, but perinatal mental disorders are of particular concern. They are already underdiagnosed and undertreated, and this has been magnified by the pandemic. Access to services (both psychiatric and obstetric) has been reduced, and in-person contact has been restricted because of the increased risks. Rates of perinatal anxiety and depressive symptoms have increased. In the face of these challenges, clear guidance in perinatal mental health is needed for patients and clinicians. However, a systematic search of the available resources showed only a small amount of guidance from a few countries, with a focus on the acute phase of the pandemic rather than the challenges of new variants and variable rates of infection. Telepsychiatry offers advantages during times of restricted social contact and also as an additional route for accessing a wide range of digital technologies. While there is a strong evidence base for general telepsychiatry, the particular issues in perinatal mental health need further examination. Clinicians will need expertise and training to navigate a hybrid model, flexibly combining in person and remote assessments according to risk, clinical need and individual patient preferences. There are also wider issues of care planning in the context of varying infection rates, restrictions and vaccination access in different countries. Clinicians will need to focus on prevention, treatment, risk assessment and symptom monitoring, but there will also need to be an urgent and coordinated focus on guidance and planning across all organisations involved in perinatal mental health care.
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Affiliation(s)
- Katharine A Smith
- Department of Psychiatry, University of
Oxford, Oxford, UK,Oxford Health NHS Foundation Trust,
Oxford, UK,Oxford Precision Psychiatry Lab, NIHR
Oxford Health Biomedical Research Centre, Oxford, UK
| | - Louise M Howard
- Section of Women’s Mental Health,
Health Service and Population Research Department, Institute of Psychiatry,
Psychology and Neuroscience, King’s College London, London, UK
| | - Simone N Vigod
- Women’s College Hospital and Women’s
College Research Institute, Toronto, ON, Canada,Department of Psychiatry, Faculty of
Medicine, University of Toronto, Toronto, ON, Canada
| | - Armando D’Agostino
- Department of Health Sciences,
Università degli Studi di Milano, Milano, Italy
| | - Andrea Cipriani
- Department of Psychiatry, University of
Oxford, Oxford, UK,Oxford Health NHS Foundation Trust,
Oxford, UK,Oxford Precision Psychiatry Lab, NIHR
Oxford Health Biomedical Research Centre, Oxford, UK,Andrea Cipriani, Department of Psychiatry,
University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK.
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26
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Ni R, Liu M, Huang S, Yang J. Effects of eHealth Interventions on Quality of Life and Psychological Outcomes in Cardiac Surgery Patients: Systematic Review and Meta-analysis. J Med Internet Res 2022; 24:e40090. [PMID: 35972792 PMCID: PMC9428777 DOI: 10.2196/40090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/12/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients undergoing heart surgery may experience a range of physiological changes, and the postoperative recovery time is long. Patients and their families often have concerns about quality of life (QoL) after discharge. eHealth interventions may improve patient participation, ensure positive and effective health management, improve the quality of at-home care and the patient's quality of life, and reduce rates of depression. OBJECTIVE The purpose of this study was to evaluate the effects of eHealth interventions on the physiology, psychology, and compliance of adult patients after cardiac surgery to provide a theoretical basis for clinical practice. METHODS We conducted systematic searches of the following 4 electronic databases: PubMed, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials. Mean (SD) values were used to calculate the pooled effect sizes for all consecutive data, including QoL, anxiety, and depression. Where the same results were obtained using different instruments, we chose the standardized mean difference with a 95% CI to represent the combined effect size; otherwise, the mean difference (MD) with a 95% CI was used. Odds ratios were used to calculate the combined effect size for all dichotomous data. The Cohen Q test for chi-square distribution and an inconsistency index (I2) were used to test for heterogeneity among the studies. We chose a fixed-effects model to estimate the effect size if there was no significant heterogeneity in the data (I2≤50%); otherwise, a random-effects model was used. The quality of the included studies was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB 2). RESULTS The search identified 3632 papers, of which 19 met the inclusion criteria. In terms of physical outcomes, the score of the control group was lower than that of the intervention group (MD 0.15, 95% CI 0.03-0.27, I2=0%, P=.02). There was no significant difference in the mental outcomes between the intervention and control groups (MD 0.10, 95% CI -0.03 to 0.24, I2=46.4%, P=.14). The control group's score was lower than that of the intervention group for the depression outcomes (MD -0.53, 95% CI -0.89 to -0.17, I2=57.1%, P=.004). Compliance outcomes improved in most intervention groups. The results of the sensitivity analysis were robust. Nearly half of the included studies (9/19, 47%) had a moderate to high risk of bias. The quality of the evidence was medium to low. CONCLUSIONS eHealth improved the physical component of quality of life and depression after cardiac surgery; however, there was no statistical difference in the mental component of quality of life. The effectiveness of eHealth on patient compliance has been debated. Further high-quality studies on digital health are required. TRIAL REGISTRATION PROSPERO CRD42022327305; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=327305.
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Affiliation(s)
- Ruping Ni
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China.,College of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Maobai Liu
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China.,College of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Shunmin Huang
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China.,College of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Jing Yang
- Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China.,College of Pharmacy, Fujian Medical University, Fuzhou, China
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27
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Abstract
Background: The prevalence of perinatal mood and anxiety disorders has significantly increased with the COVID-19 pandemic. In parallel, the pandemic has caused a major shift in delivery of care to telemedicine.Purpose: This article aimed to discuss the different advantages and disadvantages of telemedicine for perinatal mental health. Telemedicine has significant benefits for perinatal mental health patients, including increased accessibility to specialized care, direct observation of child-parent interactions in their home environment, and facilitation of collaborative work between obstetrical providers and psychiatrists. Alternatively, telemedicine may impede recovery and contribute to an increase in social isolation. The use of telemedicine by obstetrical care providers may also contribute to a reduction in screening and identification of these disorders.Conclusion: A hybrid model of in-person and telemedicine delivery of care may serve as a durable compromise solution for these women and their families.
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Affiliation(s)
- Andreanne Wassef
- Psychiatry, Centre Hospitalier de l'Universite de Montreal, Montreal, Canada
| | - Evelyne Wassef
- Faculty of Medicine, University of Montreal, Montreal, Canada
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28
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Philippe TJ, Sikder N, Jackson A, Koblanski ME, Liow E, Pilarinos A, Vasarhelyi K. Digital Health Interventions for Delivery of Mental Health Care: Systematic and Comprehensive Meta-Review. JMIR Ment Health 2022; 9:e35159. [PMID: 35551058 PMCID: PMC9109782 DOI: 10.2196/35159] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has shifted mental health care delivery to digital platforms, videoconferencing, and other mobile communications. However, existing reviews of digital health interventions are narrow in scope and focus on a limited number of mental health conditions. OBJECTIVE To address this gap, we conducted a comprehensive systematic meta-review of the literature to assess the state of digital health interventions for the treatment of mental health conditions. METHODS We searched MEDLINE for secondary literature published between 2010 and 2021 on the use, efficacy, and appropriateness of digital health interventions for the delivery of mental health care. RESULTS Of the 3022 records identified, 466 proceeded to full-text review and 304 met the criteria for inclusion in this study. A majority (52%) of research involved the treatment of substance use disorders, 29% focused on mood, anxiety, and traumatic stress disorders, and >5% for each remaining mental health conditions. Synchronous and asynchronous communication, computerized therapy, and cognitive training appear to be effective but require further examination in understudied mental health conditions. Similarly, virtual reality, mobile apps, social media platforms, and web-based forums are novel technologies that have the potential to improve mental health but require higher quality evidence. CONCLUSIONS Digital health interventions offer promise in the treatment of mental health conditions. In the context of the COVID-19 pandemic, digital health interventions provide a safer alternative to face-to-face treatment. However, further research on the applications of digital interventions in understudied mental health conditions is needed. Additionally, evidence is needed on the effectiveness and appropriateness of digital health tools for patients who are marginalized and may lack access to digital health interventions.
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Affiliation(s)
- Tristan J Philippe
- Department of Cellular & Physiological Sciences, The University of British Columbia, Vancouver, BC, Canada.,Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | | | - Anna Jackson
- School of Social Work, The University of British Columbia, Vancouver, BC, Canada
| | - Maya E Koblanski
- Department of Cellular & Physiological Sciences, The University of British Columbia, Vancouver, BC, Canada.,Department of Psychology, The University of British Columbia, Vancouver, BC, Canada
| | - Eric Liow
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Andreas Pilarinos
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
| | - Krisztina Vasarhelyi
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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29
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MacKinnon AL, Silang K, Penner K, Zalewski M, Tomfohr-Madsen L, Roos LE. Promoting Mental Health in Parents of Young Children Using eHealth Interventions: A Systematic Review and Meta-analysis. Clin Child Fam Psychol Rev 2022; 25:413-434. [PMID: 35184262 PMCID: PMC8858396 DOI: 10.1007/s10567-022-00385-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 12/11/2022]
Abstract
Parent stress and mental health problems negatively impact early child development. This study aimed to systematically review and meta-analyze the effect of eHealth interventions on parent stress and mental health outcomes, and identify family- and program-level factors that may moderate treatment effects. A search of PsycINFO, Medline, CINAHL, Cochrane and Embase databases was conducted from their inception dates to July 2020. English-language controlled and open trials were included if they reported: (a) administration of an eHealth intervention, and (b) stress or mental health outcomes such as self-report or clinical diagnosis of anxiety and depression, among (c) parents of children who were aged 1–5 years old. Non-human studies, case reports, reviews, editorials, letters, dissertations, and books were excluded. Risk of bias was assessed using the National Institutes of Health (NIH) Study Quality Assessment Tools. Random-effects meta-analyses of standardized mean differences (SMD) were conducted and meta-regressions tested potential moderators. 38 studies were included (N = 4360 parents), from 13 countries (47.4% USA). Meta-analyses indicated eHealth interventions were associated with better self-reported mental health among parents (overall SMD = .368, 95% CI 0.228, 0.509), regardless of study design (k = 30 controlled, k = 8 pre-post) and across most outcomes (k = 17 anxiety, k = 19 depression, k = 12 parenting stress), with small to medium effect sizes. No significant family- or program-level moderators emerged. Despite different types and targets, eHealth interventions offer a promising and accessible option to promote mental health among parents of young children. Further research is needed on moderators and the long-term outcomes of eHealth interventions. Prospero Registration: CRD42020190719.
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Affiliation(s)
- Anna L MacKinnon
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada
| | - Katherine Silang
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Kailey Penner
- Department of Psychology, University of Manitoba, 66 Chancellors Cir., Winnipeg, MB, R3T 2N2, Canada
| | | | - Lianne Tomfohr-Madsen
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Leslie E Roos
- Department of Psychology, University of Manitoba, 66 Chancellors Cir., Winnipeg, MB, R3T 2N2, Canada.
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